Abstract
In order to re-evaluate the significance and diagnostic value of electrocardiographs (ECG) and vectocardiographic (VCG) criteria for left ventricular hypertrophy (LVH), 56 hypertensive patients were studied by M-mode echocardiography, ECG and VCG. Parietal thickness (S $ PW) was normal (< 22 mm) in 34 and increased in 22 others. L V diameter was normal in 44, and was increased in 12. The index of left ventricular mass (Devereux-Reicheck) was less than 120 g/m2 in 34 hypertensives and greater than 120 g/sol;m2 in the 22 others. (1) While voltage indices were correlated with LV wall thickness, correlations with mass were less significant. ECG indices were more significant than those for the VCG; the best correlations were obtained for the precordial indices (Sokolow, Lepeschkin, Simonsori), while the remaining indices, including axis, duration, repolarization and surface area, yielded only mediocre correlations. (2) The diagnostic score (sensitivity $ specificity/2) was good for the following ECG voltage parameters: Lepeschkin > 30 (73%); SVI $ R V5–V6 > 30 (72%), Estes score ≥ 4 (72%), and the following VCG criteria: surface > 2 (71%), V max-T angle > 60° (71%). Sensitivity of the voltage indices decreases with dilation of the left ventricular cavity. (3) Grouping of the ECG criteria (duration, repolarization, axis and voltage) resulted in only a minimal increase in the diagnostic score. On the other hand, for the VCG, grouping together the maximum spatial vector, the surface, the QRS-T angle, the initial vector and the duration for analysis, increased the score to 81%. (4) In hypertension, the P wave is an indirect index for LVH. Its duration and the Morris index were better correlated with left ventricular thickness and mass than with the dimensions of the left atrium. (5) Despite sophisticated ECG and VCG analysis the echocardiogram remains the method of choice for the evaluation of LVH.
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